Maternal Health in Utah: Key Findings

• A recent report indicates that about 70% of maternal deaths in Utah could have been avoided.
• Mental health issues, substance abuse, and obesity are identified as the primary contributors to poor maternal health outcomes.
• The number of Utah women of reproductive age experiencing physical or mental health challenges is on the rise.

Maternal health outcomes in Utah show significant disparities, particularly affecting racial and ethnic minorities, older mothers, and those in rural areas.

This conclusion arises from a new report on maternal health factors, workforce issues, and access to care, published by the Kem C. Gardner Policy Institute at the University of Utah. The report was released alongside a panel discussion.

Produced in conjunction with the Utah Department of Health and Human Services, the report reveals that a staggering 70% of maternal deaths in Utah might have been prevented. Maternal health encompasses a woman’s health during pregnancy and for a period afterward.

The leading causes of adverse outcomes include mental health conditions, substance use disorders, and obesity.

However, several combined factors contribute to these unfavorable maternal health outcomes, including deteriorating mental and physical health over the past decade, substance abuse, partner violence, access to health care, and broader social issues such as poverty, food insecurity, and transport difficulties.

The report emphasizes that the presence of risk factors for poor maternal health varies based on individual circumstances, particularly proximity to maternal health services.

In some areas, particularly in rural Utah, women may need to travel over an hour to reach the nearest birthing hospital. Many who live far from care may not afford to take time off for appointments, as noted by panelist Danielle Pendergrass, a nurse consultant from Eastern Utah Women’s Health.

She pointed out income and location as significant barriers to receiving proper prenatal care, stating that it’s considered a good day when women in her community only need to take a half day off work for an appointment.

Moreover, the report highlighted a rising trend of Utah women of reproductive age facing physical or mental health issues, which increases the risk of complications.

Still, Utah performs better than the national average in maternal health, recording 16 maternal mortality cases per 100,000 live births, compared to 23 nationally. For severe but non-fatal outcomes, Utah averages 61 per 10,000, against a nationwide average of 88.

Data from the Utah birth certificate database reveals nearly 45,000 live births in 2023, with around 60% of mothers residing in Salt Lake or Utah counties. A significant majority of these births, approximately 83%, were attended by physicians; 13% by certified nurse midwives, and a small fraction by other midwives or practitioners. Notably, there are counties without any birthing hospital.

Assessing Risk Factors

The report indicates that pre-pregnancy risk factors, such as obesity, diabetes, and hypertension, are more prevalent in rural counties of Utah. Over 19% of births in 2023 occurred in areas with high rates of these risk factors. Sexually transmitted infections also show higher prevalence rates, especially in Wasatch Front counties and San Juan County.

Issues of poor physical health are more pronounced among racial and ethnic minorities and individuals living below the poverty line, particularly in counties like Piute, Wayne, Carbon, Sevier, and Emery.

In the last decade, the rate of poor mental health among Utah women has increased by nearly 19%. Almost 40% of women of childbearing age in Utah are diagnosed with depression, and 1 in 6 face postpartum depression symptoms.

Interestingly, the report notes that only 55% of women with anxiety or depression symptoms during pregnancy seek help from healthcare providers.

About 43% of women aged 18-44 living below the poverty line report poor mental health, contrasting with 34.4% of those above that threshold.

Substance use not only detrimentally affects outcomes for mothers and babies but also discourages pregnant women from pursuing prenatal care.

A lack of health insurance compounds the problem, especially among women from racial and ethnic minority backgrounds and those in rural counties.

Moreover, intimate partner violence during pregnancy links to various mental health issues and increased maternal death risk, alongside premature births and fetal injuries.

Kasey Shakespear, executive director of the Rural Health Association of Utah, pointed out cultural barriers in rural communities, where people often hesitate to seek help. The fear of judgment for mental health struggles makes access even more challenging.

Sarah Woolsey, medical director at the Association of Utah Community Health, noted telemedicine as a promising solution for women far from care. Still, she emphasized the need for a stronger workforce and community support systems for women to thrive.

Concerns About Workforce Shortages

Melanie Beagley, a senior health research analyst at Gardner Institute, revealed that four counties lack family physicians, 13 have no OB/GYNs, and 12 do not have certified nurse midwives. These workforce gaps are particularly problematic in maternal health, as many counties face primary care shortages—even as nearly 80% of births in 2023 occurred in those areas.

More than 28% of women who die during or after pregnancy have at least one barrier to care, including financial difficulties (23%) and transportation issues (14.9%).

The report found that there is no surplus of any maternal care professionals, from nurse practitioners to community health workers. Projections suggest that Utah will struggle to meet maternal health needs across multiple specialties in the coming years.

By 2036, it’s expected the state will have enough certified nurse midwives, but only 72% of the necessary family practice doctors and 57% of required OB/GYNs. In 2025, available OB/GYNs will meet about 69% of demand, and these specialists may not be in easily accessible locations. Without change, unmet maternal health needs are likely to persist, according to Beagley.

Many rural counties may continue to experience provider shortages, including a deficit of midwives, as highlighted by Shakespear when discussing Wayne County’s lack of available healthcare providers. The shortage extends beyond maternal health to include family physicians, critical for managing uncomplicated pregnancies and addressing mental health issues.

Ashley Moretz, a deputy division director in the Utah Department of Health and Human Services, noted that state officials, including the governor, are actively addressing these issues. He highlighted Utah’s collaborative culture as a potential strength in tackling these challenges.

Data Collection for the Report

The report’s data was gathered at the county level from various sources, including organizations like the American Medical Association, March of Dimes, hospital databases, and interviews with maternal health stakeholders. Insights on barriers and efforts to improve maternal health outcomes were also included, focusing on various challenges including mental and physical health care access and substance use treatment, particularly for communities facing significant hurdles.